Medical ethicss re: new ebola serum

It appears there may be a new way to fight ebola, since an experimental serum appears to have had a nearly miraculous effect in its first application to a young male American doctor who had caught ebola. A second victim, a middle-aged female volunteer aid worker, also American, has also received the serum, and she's improving, apparently, though not as quickly as the doctor.

All the networks have medical experts, doctors, commenting on the disease and explaining how the serum works, but you can almost sense them hoping they aren't asked about the ethical aspects. You see, there normally are protocols to be followed before that would forbid just giving an experimental and unproven drug to someone outside these protocols.

Normally, it takes years of first animal tests before CONTROLLED tests on humans are tried. The controls are there to make sure that (a) the drug works as hoped and (b) has no deleterious side effects.

These protocols have been a major source of friction and frustration because many a person has died for the lack of a drug which later on was proved to meet effectivness and safety standards.

Finally, there's the sticky question of why were two Americans chosen as test subjects rather than two of the African victims?

Replies to This Discussion

They need to work on this, as basically this virus has gone viral. I don't think it is contained. In order to survive it, you need one good immune system, lots of rest and need assistance with fluids etc, I don't many can survive it alone just with relying on the immune system.

The serum would save a lot of lives, actually when sick with such a virus knowing your chances of surviving are extremely slim, I know myself if I had it, I would volunteer to be a test subject, since it might or may increase my chances of survival and also save lives other than myself.

I don't know why the African people were given the choice choose to be involved in the medical research for the serum , or choose to bank on their immune systems to survive.

I have few qualms about the ethics of bypassing usual protocols in testing the serum that might slow or mitigate the effects of this virus. Given the nature of the symptoms, the high mortality rate, and the speed with which it is spreading, I see no reason not to fast-track the process. This disease can kill within days of symptoms manifesting; time is of the essence. The people on whom the serum is being used have little to lose, and possibly everything to gain, and the fact that they are themselves medical personnel means they are more than capable of assessing the risks inherent in allowing themselves to be test subjects, and making an informed choice, which may be one of the reasons that they were chosen to be the first on whom the serum was tested.

Certainly, just being Americans works in their favor. You're an American, you have access to American doctors and healthcare, for what it's worth. It isn't fair, necessarily, but there it is. In addition, in a very real sense, these individuals are the first responders to a potential disaster that is less immediately traumatic than a bomb blast or a natural disaster, but could be no less devastating in terms of loss of life. If we do not care for our first responders, who will be there to respond? Saving the lives of the doctors who are willing to risk themselves to care for those who are ill seems like an eminently ethical thing to do, in my opinion. .

Pleased to meetcha! I'm daughterofkarl, and new to the forum. Thank you for the provocative post!

But there are African doctors, too, and while there's a chance this American doctor may go back, he may also think he's pressed his luck enough and stay here in the US, whereas curing an African doctor would seem to have more benefit in Africa where ebola is raging.

Imagine...giving the drug to the African doctor...imagine the African doctor dying from complications....imagine the backlash that untested and unapproved medicine was given to that African doctor...you know what type of backlash it would bring on??

We all know what happened to basic polio vaccinations in the Middle East where it was deemed by the taliban to be a "weapon" by the West to target the people and cause them to be sterile, etc...resulting in millions of people not being vaccinated and the disease to flare up after years of being dormant...

"in Cameroon in 1990, rumors and fears that public health officials were administering a range of childhood vaccines to sterilize women thwarted the country’s immunization efforts.[18]Similarly, in Tanzania in the mid 1990s, a missionary raised concerns about tetanus immunizations, sparking sterilization rumors and halting the campaign.[17] And in 2005, measles vaccine suspicions led to decreased vaccination rates and increased infections in Nigeria.[19]"

Basically I think they are wise not to have rushed into the region and use it on the local population...it could do much more harm than good if it doesn't work...and I am not only referring to the possible death of the particular doctor.

I think there is something called a mercy procedure, in which experimental drugs can be used as a last ditch effort, since not applying the medicine would be worse than what the potential side effects could do.
Doing this wouldn't bypass the protocols, as the testing still needs to commence in order for the drug to be fully used in the medical field.
I'm not sure whether the results of the mercy procedure should have a place somewhere in the test results though.

There have been plenty of final stage cancer patients who've run out of options and would be happy to try something experimental, but typically such cases are denied access to experimental drugs. I think your "mercy procedure" is a myth based on wishful thinking.

Here in the United States they, the doctors, would be bound by laws prohibiting their use of the vaccine; but Africa?

Ethics. Here in the United States the Food and Drug Administration denied Aids patients the use of a medication that would help them with their symptoms. It wasn't a cure but it does expand life expectancy. See "Dallas Buyers Club". The FDA prohibited it's use. Later they fast tracked it.

Ethics: Who's ethics? The bible thumping crowd that denies a woman freedom of choice? The megalomaniac's who own pharmaceuticals that influence politicians to vote against a drug because it will have an effect on their bottom line?

Informed consent, to me, is the critical part of the ethical question. Are potential recipients of the serum aware of the risks before they agree to it? How much understanding of the workings of the serum is required or is it enough to say "you will die without it"? Are they of sound enough mind to consent; are they feverish, hallucinating, so terrified they will agree to anything? If they are unconscious, who has medical power of attorney?

Maybe drug trial protocols should be reconsidered. It seems to me that with decades of data related to how various medications interact with the body, research doctors will become better at predicting how new compounds will work. They're not totally shooting in the dark anymore. Shouldn't that shorten trial times?

Why Americans? Maybe the doctor was better able than most to give informed consent.

Informed consent, to me, is the critical part of the ethical question. Are potential recipients of the serum aware of the risks before they agree to it?

Perhaps what you mean is that people should be allowed to accept the risks in extreme cases, even if they don't know what they are.

Discovering the risks, determining correct dosages, etc., is why the protocols are there in the first place. The "informed" part of "informed consent" means, in the case of drugs, having that sort of information. As I understand it, the only tests so far have apparently been on monkeys, who are usually, though not always, good models of whether a drug is effective on humans. Drugs, and even foods, that are harmless to humans can kill dogs and cats, and there's no reason to assume that simply because something works on monkeys, it can't be dangerous to humans.

Another point I hadn't considered is how much of a given experimental drug is even in existence. I assume they only make small quantities for testing purposes, without intending to distribute it beyond the lab. A trend of people taking drugs that had not fully passed the testing protocols could be problematic.

I've been in school overtime this summer, and didn't even know of this story! Quite interesting. I read up a bit on it, days late, but late reading of news has its advantage of skipping over the wild and speculative reports. Anyway, from what I've read...

Two separate questions: Americans vs. Africans. We obviously have no say in how non-Americans should be dealt with.

As for how I feel about ethical treatment of Americans... to my limited knowledge, antibodies (in this case, monoclonal antibodies) are made very specific, and their targets should, by design, be specific pathogens. I would definitely volunteer to this one, even with my limited knowledge, and believe it's absolutely ethical to let medical professionals make their own decisions in this kind of fast-moving crisis, as long as appropriate attention is paid to documenting the treatment and outcomes.

Another huge, potential problem in an uncontrolled epidemic (as in Africa), is the unintended consequence of the development of resistance by the pathogen. Boko Haram (et al) would have a field day with that.